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Information Collection

Individualized Service Plan (short Form, Extended Form 1 And 2)

IC 166113 under ICR 197905-0938-007 · OMB 0938-0057.

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Information Collection (IC) Details

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INDIVIDUALIZED SERVICE PLAN (SHORT FORM, EXTENDED FORM 1 AND 2)
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-3407 No No
Form SSA-3407B No No


    

60 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 60 0 0 0 0 60
Annual IC Time Burden (Hours) 11 0 0 0 0 11
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.